As we prepared for our initial accreditation survey from the Texas Department of Health last year, we knew that surveyors would ask about how we document, secure and account for narcotics. We developed a narcotics form that follows the patient through pre-op, intraop and post-op, and that's linked to our drug inventory.

During pre-op, when the anesthetist is issued the narcotics he's requested, we hand him the form with a patient label on it. During surgery, he marks the drugs and amounts he's used, getting a signature for any disposed-of portions, and returns the unused drugs to us. The form follows the patient to recovery and discharge, recording what he's given for pain, then it goes to the nurses who check the narcotics inventory at day's end. We can compare the narcotics forms against our perpetual inventory sheets to match up what was taken and what's been used; if there's any discrepancy, we can ask about it.

Our form is simple, easy to read and complete, with color-coding to distinguish between different doses of the same medication. Our anesthesiologists and CRNAs have been compliant.

Kris Fisher, RN, CNOR, BSN
Nurse Administrator
Turtle Creek Surgery Center
Tyler, Texas
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Caring for Mom and Dad During Their Child's Surgery
Caring for a pediatric patient's family is as important as the care the patient is getting. We've taken a few steps to keep the family involved in the process: pre-op tours of the center for the patient and his family; an information sheet on what to expect on the day of surgery (so they won't feel as if they've been rushed out or waiting too long) and a snack tray that we take out to waiting family members. Our waiting room volunteers offer family members coffee, make 30-minute rounds to update them on the status of their child's procedure, introduce them to the physician when he comes out to speak with them after surgery and take them to a conference room for private discussions.

Cindy L. Ladner, BSN, RN, CAPA
Manager
Shawnee Mission Surgery Center
Shawnee Mission, Kans.
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Streamlining Pre-admission Testing
Want to save time and cut down on cancellations and delays? Instead of having patients come to your center for pre-admission testing, try to get everything done ahead of time. Once surgery has been scheduled, call to interview patients and forward them a health-screening form with the goal of their receiving it a week before their procedure. Include what's required in the way of lab testing, X-rays and EKGs. They can take that form to their doctor's office or wherever their physician directs to have the testing done, based on guidelines established by our anesthesiologists. This step saves them a trip and, after the initial doctor's appointment, they don't have to show up until the day of surgery.

Rachel Bain, BS, RN, CNOR
Clinical Nurse Manager
North Country Orthopaedic Ambulatory Surgery Center
Watertown, N.Y.
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Report Cards for Surgeons
A procedure cost analysis lets you know how much time and money your surgeons are spending. But how do you relay that to those doing the spending?

To compile data for a given procedure, track the average OR time and average preference card supply cost for each physician. These are two factors over which the physician has significant control.

Publish the data in a quarterly report - we use bar charts - comparing each physician's average time and cost. We don't list the physicians' names on the charts, but instead assign each a code number. We hand-deliver or mail the report to the physicians and send them a postcard letting them know which numbers represent them.

Identifying the cost differences between physicians led our center to analyze individual preference cards and procedures. That sort of analysis suggested, for instance, that we purchase reusable leg holders for orthopedic procedures instead of disposable leg stirrup straps, and that our staff drape the patient as soon as possible instead of waiting for the physician to arrive. We met with our ortho surgeons to gain their support for these discoveries.

Julie Butner, BSN, MSA
Executive Director
El Camino Surgery Center
Mountain View, Calif.
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Utility Players, One and All
None of the staff at our surgery centers has a defined role. They're nurses and techs and supervisors, of course, but everyone pitches in what she's capable of doing, whether it's filling in for someone who's out, scrubbing in to assist a surgery or mopping a floor. No job is above or beneath them, and there's no discord about it.

Lorraine Melancon, RN
Quality Management Coordinator
HealthEast Outpatient Surgery Centers
St. Paul, Minn.
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Let Staff Speak Up at Staff Meetings
We have a staff meeting on the first Thursday of the month at 6:30 a.m., one half-hour before the first scheduled surgery. Some complained that the managers were doing all the talking, leaving them little time to voice their concerns. In response to that, we now publish a newsletter that everyone gets in her office mailbox a week before the meeting. It's nothing fancy: just the information we've collected from our nurse administrator and materials manager, printed on the center's letterhead. They read it, and we can get on to other things.

It's working really well. It increases staff involvement in meetings, because now they have the opportunity to raise the ideas they've come up with, and staff members have told me they're more comfortable bringing up their own concerns.

Janine Orth, RN, BSN, CNOR
Nurse Manager
Glasgow Ambulatory Surgery Center
Newark, Del.
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